NDAC 75-09.1-11-15
Medical expenses reimbursement
Cite as N.D. Admin. Code § 75-09.1-11-15
1.
A program that is also an institution for mental diseases may submit a request for
reimbursement of medical expenses if:
a.
The individual is deemed eligible for the substance use disorder treatment voucher in
accordance with subsection 5 of section 75-09.1-11-07;
b.
The individual's suspension of medical assistance is due to the individual being in an
institution for mental diseases;
c.
The program properly documents and submits a request for medical expenses
reimbursement in the form and manner prescribed by the department;
d.
The program allows the department access to necessary records to determine if the
reimbursement of medical expenses is appropriate;
e.
The program submits a new request for reimbursement of medical expenses for each
request;
f.
The approved payment being made by the department is to reimburse the program's
actual cost; and
g.
The department's approved payment does not exceed the total amount appropriated for
medical expenses reimbursement.
2.
Payment on a request for reimbursement of medical expenses may be denied if:
a.
A revocation of the program's participation in the voucher system has occurred prior to
the date the medical expenses were incurred by the program;
b.
The program fails to comply with the terms and conditions of the signed agreement
between the program and the department;
c.
The program fails to comply with or enforce the program's policies submitted as required
by subsection 3 of section 75-09.1-11-02;
d.
The program does not have a valid substance abuse treatment program license on the
date the medical expenses were incurred by the program;
e.
The program fails to properly document and submit a request for reimbursement of
medical expenses in accordance with this section;
f.
The program submits a request for reimbursement of a medical expense that is not an
approved expense;
g.
Appropriated funds for the reimbursement of medical expenses have been exhausted;
h.
The program is not an institution for mental diseases; or
i.
The program fails to comply with this section.
3.
The department shall issue a payment for reimbursement of medical expenses if the request
and payment is in accordance with this section and within the limits of appropriated funds for
the reimbursement of medical expenses.